Claims Examiner - Workers Compensation | Jurisdiction: CA | Dedicated Client - Remote

Sedgwick Claims Management Services Ltd; Cameron Park (CA); Hybrid; USD 70,000 - 82,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development and growth

Job summary

Sedgwick Claims Management Services Ltd seeks a skilled claims examiner to analyze workers' compensation claims for our clients. The role emphasizes benefit determinations, timely adjudication, and strong client communication in a CA-hybrid environment.

Ideal candidate has 5 years’ claims experience, CA license knowledge, and a Bachelor’s degree is preferred. Flexible schedule and professional growth opportunities are offered as part of Sedgwick’s supportive benefits package.

Qualifications

• Education: High School Diploma or GED required; Bachelor's degree preferred.
• Experience: 5 years of claims management experience or equivalent.
• Licensing/Jurisdiction: CA required.

Responsibilities

• Analyze workers' compensation claims to determine benefits and adjudicate within service expectations.
• Negotiate settlements within designated authority.
• Communicate claim activity to claimants and clients; report to excess carrier when needed.

Skills

Claims management

Negotiation

Client communication

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Workers Compensation | Licensing & Jurisdiction: CA - Hybrid

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

WHY JOIN US

ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

PRIMARY PURPOSE OF THE ROLE

To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

QUALIFICATIONS

• Education & Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
• Experience: 5 years of claims management experience or equivalent combination of education and experience required.
• Licensing / Jurisdiction Knowledge: CA Required

TAKING CARE OF YOU

• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.

WORK ENVIRONMENT REQUIREMENTS INCLUDE

• When applicable and appropriate, consideration will be given to reasonable accommodations.
• Mental:Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
• Physical:Computer keyboarding, travel as required
• Auditory/Visual: Hearing, vision and talking
• As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is (70-82k)
• A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the LosAngeles County Fair Chance Ordinance for Employers, the City of LosAngeles’ Fair Chance Initiative for Hiring Ordinance, the SanDiego Fair Chance Ordinance, the SanFrancisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway!

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

For more, see sedgwick.com